Increasing Organ Donation In The United States
Organ Donation in the United States is undoubtedly an important topic that is severely under addressed. While there are over 156 million people registered to donate organs to those in need, more than eight thousand people succumb each year while waiting for a lifesaving organ in the United States. I am almost positive that you know the feeling of wanting something but not being able to have it. Maybe it is your favorite curling iron that has been out of stock online for months. You place a special order, but you still must wait what seems like an eternity for a curling iron, how disappointing, luckily for you, you will not die without a curling iron. Similarly to organ transplantation, it may not necessarily be that you cannot afford it, but that it is simply not available to you, although it is out there, can be frustrating to say the least. The topic of organ donation in the united states needs to be further addressed and we must do more as a country to halt the shortage of available organs in our country to help save more lives. It is unique and challenging in this field of such sophisticated medicine that the major impediment to life-saving treatment is not science, but rather the human element.
Now, let us say that there are 10 special edition Ferrari’s roaming the streets of America that are worth one million dollars each. You have one million dollars to anyone who will sell it to you, but for the people who do have it, they have decided that it doesn’t matter, they want the Ferrari because its theirs and its simply not worth it to get rid of it, there is no real benefit to them. Based on that logic, you are out of luck, so, so much for that luxury car that you want. Is this similar to people who are not willing to donate their organs, there is just simply no benefit to them? Now, instead of wanting something you cannot have, what if you needed something you could not have? What if the thing you needed were a lifesaving organ? If you were on an organ transplant wait list, you would be one of one hundred and twelve thousand people waiting for a lifesaving organ transplant. Without a perfect match for you, you could become one of the eight thousand people per year who die because organs are not donated in time. What if the perfect match for you were out there walking around, they have no idea that you need an organ, or they have simply decided organ donation is not for them? How can we change the statistic of eight thousand people dying every year? What are the reasons why people choose not to donate?
Let’s start off by talking about what exactly organ donation in the United States consists of. According to Organdonor.gov, one hundred and twelve thousand men, women, and children were on the national transplant waiting list as of March two thousand twenty, and another new person is added to the waiting list every ten minutes (“Organ Donation Statistics | Organ Donor”).As stated earlier, there are over one hundred and fifty-six million registered donors nationally, more than half of the population in the United States. So, we find ourselves wondering why do we have such a shortage of available organs? The truth of the matter is that only about three in every one thousand donors die in a way that makes them eligible for organ donation. What does that even mean? Mathematically speaking, that means that out of one hundred and fifty six million people, only four hundred and sixty eight thousand will be eligible to donate their organs, which is a drastic reduction in the number of donors from one hundred and fifty six million. You may be saying there are only one hundred and twelve thousand people on the waiting list, that is four times the number of available organs we need. However, we must consider that there is a matching process, and just because someone is eligible to donate, does not necessarily mean they are a match for one who needs the organ.
When matching organs from deceased donors to patients on the waiting list, many factors are taken into account, such as blood type, body size, severity of the patients medical condition, distance between the donor and patients hospital, and whether the patient is available at the time, meaning the patient has no current infection, or another temporary reason the transplant could not take place. In some cases, depending on the organ, some factors are more important than others, such as how close the patient is. Being that certain organs can only spend a limited amount of time outside of the body, for instance the heart, can spend only four to six hours outside of the body, whereas a kidney can spend twenty-four to thirty- six hours outside the body, These factors play a huge role in donation statistics and are just one of many reasons why there is such a shortage of organs.
Education on the subject, a possible change of policy in the united states, expanding the criteria for potential deceased donors? Some say that these things will not actually yield a significant number of donors to close the gap, but I contest that even a few more donations are better than none. Some of the reasons why people choose not to donate their organs are they think they are too young, or in contrast, too old. Some believe that their religion does not support organ donation, or that a “bad person” is going to get their organ, or that the rich and famous have priority in organ transplant. Perhaps they believe that if it is known that they are an organ donor, doctors will not work as hard to save their lives, or that they are not in the best of health and no one would even want their organs. This pervasive gap in knowledge and misunderstanding surrounding organ donation contributes to the development of erroneous beliefs and myths, an important element in hesitancy to register, so let me bust some of these myths for you.
As previously stated, some people believe that organ donation is against their religion, however, upon further examination it has been found that many religions not only recognize and approve of organ donation, but encourage it. With that, most religious rules and concerns are overcome by the principal of altruism, which is the selfless concern for the well-being of others. For example, Jehovah’s Witnesses are often presumed to be opposed to donation because of their belief against receiving a blood transfusion. This does pose a slight problem if the donor were to need an emergent blood transfusion, but there are techniques that can be used. For example, autologous blood donation. Autologous blood is blood that is donated by the patient, which can be used later if a post-surgical transfusion is needed. Blood is taken from six weeks to five days before surgery, it is then stored, and able to be used by the person who donated it, for up to a few weeks post collection. If the blood is not used, it is discarded (Blood Donation before Surgery). For a transplant recipient who is a Jehovah’s Witness, this merely means that all blood must be removed from the organs and tissues before being transplanted, and while it does complicate things, there are a number of techniques that can be used to successfully transplant. According to Dr. Ngoc Thai, a transplant surgeon at Allegheny General Hospital, organs can be flushed clean of the donor’s blood. Dr. Thai stated that he had performed several surgeries on patients who are Jehovah’s Witnesses, and recognizes the importance of respecting the beliefs and decisions of those patients. Therefore, all procedures were done without the use of banked blood, and with clean organs (Bloodless Medicine Specialties). It is possible for people of many religions to donate and receive organs. However, education on the subject is fundamental, and a key factor in increasing rates of organ donation. Having the information to make informed choices is essential, and we must continue to educate so these misconceptions can be thwarted.
Another misconception is that if it is known that you are an organ donor you may be treated differently or that death may be hastened. Undeniably so, the decision to become an organ donor is a significant expression and exercise of personal autonomy, and with that, careful attention to ensuring quality end of life care is paramount. Current practice puts a standard on ensuring patients comfort are met. These practices are consistent with national standards for end of life care and should offer reassurance that care is not directed toward accelerating death, but instead toward honoring the patients wishes.
Could a presumed consent or an “opt out” policy be adopted and implemented in the united states and be feasible? According to University of Michigan, it has been estimated that lack of consent plays a role in preventing donation from up to 40% of otherwise eligible donors in the United States (Moore, par.14). It should be noted that opt out policies have been effective, along with other measures in several other countries. Spain introduced their current opt- out policy in 1979, this means that individuals are presumed to want to donate their organs unless they explicitly object to doing so. The Spanish system of organ donation has long been considered the ‘gold standard’ of deceased organ donation (Willis and Quigley, par.8). Can Spain’s success be contributed to and solely based upon the opt out policy? Opt out policies reduce the grieving family’s burden of decision making, just as the current opt in policy of the United States does. One concern with the opt out policy is a mistaken presumption about the wishes of individuals who did not have the chance to opt out. Therefore, it is extremely important for vigorous public education on the matter, there should also be safeguards, as well as easy and reliable ways to opt out that would not be troublesome. Some critics also argue that this policy would be unfair to individuals who do not speak English, those who cannot read and write, or those who may have difficulty in expressing refusal or understanding the system. “This concern could be addressed, in part, by developing and undertaking special educational efforts in minority communities: by creating handy, easy, and nonburdensome mechanisms for registering dissent; and by consulting the family of the decedent.” (Institute of Medicine (U.S.). Committee on Increasing Rates of Organ Donation. 220) Some also argue that this policy “would deprive individuals of the exercise of the virtue of generosity” (Ramsey et al. 210). I insist that a policy of presumed consent should not prevent individuals from feeling acts of generosity, as the act of non-refusal or non-objection to the opt out policy would surely be generous in itself. Lastly, what we do know for sure is that a policy of presumed consent will fail without the support of the public
According to a study on Pub Med titled “Importance of Education in Organ Donation,” researchers gathered information on a military base between January and March of two thousand ten. The study evaluated the effects of education about organ donation and transplantation, and the numbers were astounding. A questionnaire was given prior to education on donation, and then again 2 months after the educational lesson was given. The study showed that the rate of volunteering for organ donation increased from forty-five-point four percent to eighty-four-point eight percent. Similarly, the rate of consent for organ donations by relatives increased from forty-one percent to eighty-point three percent. Strikingly, general knowledge about organ donation increased from thirty-four-point eight percent to ninety-three-point seven percent, and it was noted that inaccurate beliefs about organ donation and transplantation had completely disappeared. The results of this study show that with the drastic increases shown here, education alone can become widespread and increase the rates of organ donation on a much larger scale.
The fundamental principle that bounds the entire system together, is education. Simply put, insufficient education of any concept pertaining to organ donation is detrimental. Whether it be education on the myths or erroneous beliefs, or education on how a policy shift could benefit America. The lack of educational courses, the refusal to consent to organ donation, which is often based on misinformation means that instead of reducing the organ transplant waiting list, it will only continue to grow as population continues to rise. I believe it is the key answer to move forward in the right direction. It is not that we are unable to successfully accomplish organ transplants, rather there are not enough people who are educated on the topic to be willing to donate their organs.
- “Blood Donation before Surgery.” Mount Sinai Health Systemwww.mountsinai.org/health- library/discharge-instructions/blood-donation-before-surgery.
- “Bloodless Medicine Specialties: Organ Transplantation Without Blood: Allegheny Health Network.” Allegheny Health Network, 16 Apr. 2020, ahn.org/services/medicine/bloodless- medicine/faq/organ-transplant.
- [bookmark: _Hlk43762784]Institute of Medicine (U.S.). Committee on Increasing Rates of Organ Donation. Organ Donation: Opportunities for Action. Washington, D.C, The National Academies Press, 2006, ebookcentral.proquest.com/lib/hvcc-ebooks/detail.action?docID=3378122#.
- Moore, Nicole Casal. “How Opt-Out Donation Could Affect U.S. Waiting Lists.” Health News, Medical Breakthroughs & Research for Health Professionals, 25 Oct. 2019, labblog.uofmhealth.org/industry-dx/how-opt-out-donation-could-affect-us-waiting-lists.
- “Organ Donation Statistics | Organ Donor.” OrganDonor.Gov, www.organdonor.gov/statistics- stories/statistics.html. Accessed 8 June 2020.
- Ramsey, Paul, et al. The Patient as Person, Second Edition: Exploration in Medical Ethics. 2nd ed., Yale University Press, 2002.
- Willis, Brian H., and Muireann Quigley. “Opt-out Organ Donation: On Evidence and Public Policy.” PubMed Central (PMC), 1 Feb. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3914429.
- Yilmaz, Tonguc Utku. “Importance of Education in Organ Donation.” PubMed, Dec. 2011, pubmed.ncbi.nlm.nih.gov/22142043.